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Comparison of a patient-controlled analgesia system with continuous infusion for administration of diamorphine for
1Jose Carreras Bone Marrow Transplant Unit, Royal Liverpool University Hospital, UK.
Abstract:
Mucositis remains an important problem following BMT and may delay discharge from hospital. Patient-controlled analgesia (PCA) systems have been reported to be of benefit in controlling BMT-associated mucositis. The present study comprised 65 patients (age range 16-68 years; 19 allografts, 29 peripheral blood stem cell autografts and 17 autologous bone marrow). Subjects were prospectively randomised to receive intravenous diamorphine for pain relief either by conventional continuous infusion (CI) or by PCA, using a Medex Walkman 440 delivery system. Each patient assessed his/her pain control and nausea daily by a visual analogue scale. Twenty-two patients did not require any diamorphine. Four patients required diamorphine for pain other than mucositis, and four patients failed PCA control. Of 35 assessable cases, no difference in pain control was noted between CI and PCA. However, PCA-controlled patients required significantly less diamorphine than CI controlled patients (mean, 131 +/- 23 mg for PCA vs 296 +/- 40 mg for CI; P = 0.001), and PCA required fewer days of diamorphine than CI (mean, 7.17 +/- 0.66 days for PCA, 9.00 +/- 0.65 days for CI; P = 0.03). Side-effects were minimal and equivalent in the two arms. The findings suggest that PCA and CI offer equivalent control of the pain of BMT-associated mucositis, but PCA requires less total consumption and duration of diamorphine therapy.
Insights
Patient-controlled analgesia (PCA) offers effective pain management for bone marrow transplant (BMT) mucositis. PCA requires less diamorphine and shorter treatment duration compared to continuous infusion (CI), with similar pain control and side effects.
Area of Science:
- Oncology
- Hematology
- Pain Management
Background:
- Mucositis is a significant complication after bone marrow transplantation (BMT), often delaying patient discharge.
- Patient-controlled analgesia (PCA) has shown promise in managing BMT-associated mucositis pain.
Purpose of the Study:
- To compare the efficacy and safety of intravenous diamorphine via PCA versus conventional continuous infusion (CI) for managing BMT-associated mucositis pain.
Main Methods:
- A prospective randomized study involving 65 BMT patients (age 16-68).
- Patients received intravenous diamorphine via PCA or CI.
- Pain and nausea were assessed daily using a visual analogue scale.
Main Results:
- No significant difference in pain control between PCA and CI groups.
- PCA group required significantly less total diamorphine (131 mg vs 296 mg) and fewer days of treatment (7.17 days vs 9.00 days).
- Side effects were minimal and comparable between the two groups.
Conclusions:
- PCA and CI provide equivalent pain control for BMT-associated mucositis.
- PCA demonstrates superior efficiency by reducing overall diamorphine consumption and treatment duration.